Pegaptanib Sodium (Macugen)

Pegaptanib (Macugen) is covered only for neovascular (wet) AMD and the specified compendial off‑label uses listed (diabetic retinopathy, neovascular glaucoma, retinopathy of prematurity, sickle cell neovascularization, and choroidal neovascular conditions); other uses are not covered. Coverage requires administration by or under an ophthalmologist, documented intravitreous dosing ≤0.3 mg every 6 weeks, documentation of the covered diagnosis and administration, and approvals (initial and renewals) for up to 12 months.

"Neovascular (Wet) age-related macular degeneration (AMD) (FDA-approved indication)"

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